直肠癌新辅助放化疗与手术间隔时间对临床和肿瘤学结局的影响

Effects of Neoadjuvant Radiochemotherapy and Operation Interval of Rectal Cancer on Clinical and Oncological Outcomes

目的评估延长局部进展期中、低位直肠癌放疗后手术间隔时间至70天对短期临床结局及肿瘤学结局的影响。方法新辅助放化疗局部进展期直肠癌患者,根据放疗后与手术间隔时间分为短间隔组(<70天)58例和长间隔组(≥70天)65例,分析手术间隔时间与手术难度、术后并发症、病理完全缓解、无疾病生存期及总生存期的关系。结果两组患者基本信息、新辅助放化疗前肿瘤临床特征比较,差异无统计学意义(P>0.05)。长间隔组手术时间高于短间隔组,短间隔组中低位直肠癌保肛率(62.07%)高于长间隔组(55.38%),短间隔组吻合口瘘发生率(2.78%)低于长间隔组(13.89%),但差异无统计学意义(P>0.05)。短间隔组降期率高于长间期组(P<0.05);长间隔组术后病理完全缓解率(16.92%)高于短间隔组(15.52%),但差异无统计学意义(P>0.05);多因素分析显示病理完全缓解与间隔时间无关。中位随访时间为39(6~84)个月,短间隔组3年无疾病进展期为75.86%,高于长间隔组的66.20%,但差异无统计学意义(P>0.05)。短间隔组3年总生存期为86.20%,长于长间隔组的83.10%,但差异无统计学意义(P>0.05)。结论局部进展期直肠癌新辅助放化疗后延长手术间隔时间至70天会增加手术时间,但对保肛率、病理完全缓解率、短期临床结局以及肿瘤学结局无明显影响。

Objective To evaluate the effect of prolonging the interval between local and advanced rectal cancer surgery after radiotherapy to 70 d on short-term clinical outcomes and oncological outcomes.Methods Neoadjuvant radiotherapy and chemotherapy patients with locally advanced rectal cancer were divided into short-interval group(<70 d) 58 cases and long-interval group(≥70 d) 65 cases according to the interval between radiotherapy and surgery. The interval between surgery and difficulty of surgery and postoperative complications were analyzed.Syndrome,pathological complete remission, disease-free survival and overall survival.Results The basic information of the two groups of patients and the clinical characteristics of the tumor before neoadjuvant radiotherapy and chemotherapy were compared,the difference was not statistically significant( P>0.05).The operation time of the long-interval group was higher than that of the short-interval group, the anus-preserving rate(62.07%) of middle and low rectal cancer in the short-interval group was higher than that of the long-interval group(55.38%), and the incidence of anastomotic leakage(2.78%)in the short-interval group was lower than that of the long-interval group interval group(13.89%), but the difference was not statistically significant(P>0.05).The rate of decline in the short interval group was higher than that in the long interval group( P<0.05);the pathological complete remission rate(16.92%) in the long interval group was higher than that in the short interval group(15.52%), but the difference was not statistically significant(P>0.05);multivariate analysis showed the complete remission of the pathology has nothing to do with the interval time. The median follow-up time was 39(6 to 84) months. The 3-year period of disease-free progression in the short-interval group was 75.9%, which was higher than 66.20% in the long-interval group. The 3-year overall survival time of the short-interval group was 86.20%, longer than that of the long-interval group 83.10%, but the difference was not statistically significant(P >0.05).Conclusion Prolonged operation interval to 70 d after neoadjuvant radiotherapy and chemotherapy for locally advanced rectal cancer will increase the operation time, but it has no significant effect on the rate of anus preservation,pathological complete remission rate, short-term clinical outcome and oncological outcome.